Patients with macroprolactinaemia: clinical and radiological features

Donadio, F; Barbieri, A.; Angioni, Rita; Mantovani, Giovanna; Beck‐Peccoz, Paolo; Spada, Anna; Lania, Andrea

doi:10.1111/j.1365-2362.2007.01823.x

Cited by 44 publications

(36 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, dopamine agonists and surgery represent the therapy of choice for prolactinomas and pseudoprolactinomas, respectively (5)(6)(7)79). Moreover, the correction of hypothyroidism and withdrawal of the culprit drug could enable PRL normalization (3)(4)(5), while macroprolactinemia usually does not require treatment (17,21,43,59).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, macroprolactinemic patients cannot be differentiated by their monomeric hyperprolactinemia counterparts in terms of clinical and neuroradiological findings (16,44), nor by PRL levels, unless they are very high (e.g., > 700 ng/mL) (59,61,65). Although there is no consensus yet on the indications for macroprolactinemia screening, there is an increasing number of endocrinologists who consider this approach for all patients without an obvious etiology for the PRL elevation (9,16,17,21,(43)(44)(45)60,61,64,(94)(95)(96). Noteworthy, PRL measurement should be avoided in asymptomatic patients in the absence of a known pituitary adenoma to prevent challenges associated with macropro lactinemia.…”

Section: Resultsmentioning

confidence: 99%

“…Abnormal pituitary images (microadenomas, cystic lesions, empty sella or, less frequently, macroadenomas) have been reported in 8-26% of patients with macroprolactinemia (21,43,44,59,65) but this frequency is similar to that found in the general population (6-20%) (80,81). However, in a recent study involving 88 macroprolactinemic patients, 65% had abnormal MRI, compared with 81% of 244 subjects with monomeric hyperprolactinemia (44).…”

Section: Imaging Studiesmentioning

confidence: 85%

“…PRL levels were lower in macroprolactinemic patients than in those with monomeric hyperprolactinemia, but there was a great overlap between groups (43,(59)(60)(61)65).…”

Section: Macroprolactinemiamentioning

confidence: 91%

“…(42) found high prevalence of anti-pituitary antibodies (APA) in 25.7% of patients with idiopathic hyperprolactinemia, whereas all patients with microprolactinomas and normal controls were negative for APA. It is noteworthy that many cases initially diagnosed as IH were later confirmed as having macroprolactinemia (43)(44)(45).…”

Section: Idiopathic Hyperprolactinemiamentioning

confidence: 99%

See 4 more Smart Citations

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

112

View full text Add to dashboard Cite

The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22 Keywords Hyperprolactinemia; diagnostic pitfalls; hook effect; macroprolactinemia; pituitary incidentalomas RESUMO A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve--se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outr...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Imaging Studiesmentioning

confidence: 85%

“…PRL levels were lower in macroprolactinemic patients than in those with monomeric hyperprolactinemia, but there was a great overlap between groups (43,(59)(60)(61)65).…”

Section: Macroprolactinemiamentioning

confidence: 91%

Section: Idiopathic Hyperprolactinemiamentioning

confidence: 99%

See 3 more Smart Citations